Neurosurgical Review[JOURNAL]
Sun
200 papers
The impact of augmented reality on radiation exposure during spine surgery: a systematic review.
El Choueiri J, De Rossi L, Pellicanò F … +11 more , Di Cosmo L, Rota A, Pellegrini L, El-Hajj VG, Elmi-Terander A, Creatura D, De Robertis M, Baram A, Brembilla C, Panciani PP, Capo G
Neurosurg Rev · 2026 May · PMID 42149254 · Publisher ↗
BACKGROUND: Augmented reality (AR) has rapidly emerged as an important navigational technology in spine surgery, with growing interest in its potential to reduce dependence on fluoroscopy and mitigate radiation exposure...
BACKGROUND: Augmented reality (AR) has rapidly emerged as an important navigational technology in spine surgery, with growing interest in its potential to reduce dependence on fluoroscopy and mitigate radiation exposure for both patients and operating room staff. METHODS: This systematic review examined current evidence on radiation-related outcomes of AR-assisted spine procedures. A PRISMA-guided search of PubMed, Embase, and Scopus identified twelve eligible studies, including randomized trials, prospective and retrospective clinical cohorts, and cadaveric or synthetic-model investigations. RESULTS: Across the included studies, AR was consistently associated with reduced fluoroscopy use, with several studies demonstrating statistically significant reductions in exposure time compared with conventional fluoroscopy. Two clinical studies directly measured occupational radiation and reported substantially lower staff doses when AR-based navigation and optimized shielding strategies were employed. Patient radiation exposure was similarly decreased in most studies, particularly when AR was integrated with low-dose cone-beam CT protocols. Operative time findings were mixed, reflecting early learning curves and variability in AR systems, but accuracy remained high across platforms. CONCLUSION: Current evidence suggests that AR may reduce intraoperative radiation exposure without compromising workflow or surgical precision, available studies are limited by small sample sizes, heterogenous methodologies, and a paucity of direct staff-dosimetry data. Larger, high-quality multicenter studies are needed to clarify the magnitude of AR's radiation-sparing benefits and to define its role in modern spine surgery.
The outcome of microvascular decompression for hemifacial spasm associated with vertebral artery: A retrospective comparative study.
Liu S, Yang D, You C … +3 more , Luo L, Liang C, Du T
Neurosurg Rev · 2026 May · PMID 42149222 · Publisher ↗
BACKGROUND: Microvascular decompression (MVD) is an established treatment for hemifacial spasm (HFS). However, when the vertebral artery (VA) is the offending vessel (OV), the procedure is technically more challenging. W...
BACKGROUND: Microvascular decompression (MVD) is an established treatment for hemifacial spasm (HFS). However, when the vertebral artery (VA) is the offending vessel (OV), the procedure is technically more challenging. Whether MVD yields comparable safety and efficacy in VA-associated versus non-VA-associated cases remains unclear and warrants further investigation. MATERIALS AND METHODS: We conducted a retrospective analysis of HFS patients treated at our study between September 2023 to February 2024. We enrolled 51 patients with HFS assigned to the two groups in accordance with the OVs. RESULTS: A total of 51 patients with HFS were divided into the VA-associated (n = 11) and non-VA-associated (n = 40) groups. Spasm-free relief (Park YS grades "excellent" or "good") was achieved in 81.8% and 82.5% of patients in the VA and non-VA groups, respectively (p = 0.694). Early remission occurred in 45.5% of VA cases and 52.5% of non-VA cases (p = 0.904). Transient postoperative complications, including vertigo, tinnitus, hearing loss, or facial paralysis, were noted in 7 VA-associated (63.6%) and 10 non-VA-associated (25.0%) patients (p < 0.05). Mean operative times were 147 ± 20.0 min in VA group) and 131.0 ± 30.0 min in non-VA group(p < 0.05) s. No major complications were observed in either group. CONCLUSION: MVD is effective and safe for both VA- and non-VA-associated HFS. Although VA-associated cases involve greater surgical complexity and a higher incidence of transient postoperative symptoms, long-term outcomes remain comparable when adequate decompression is achieved.
Safety profile and surgical outcomes of the endoscopic transorbital approach as a skull base surgical corridor: a systematic review and meta-analysis.
Arend RB, Peroni BZ, Ribeiro FV … +14 more , da Silva Mezzari MH, Lima NL, Kieling DM, Kauer VLF, Gnoatto HP, Savaris DF, Cambruzzi G, Corin AS, Bertani R, Roman A, da Silva MBC, Vial ADM, Champagne PO, Gago G
Neurosurg Rev · 2026 May · PMID 42120790 · Full text
Endoscopic techniques have enabled minimally invasive approaches in neurosurgery, providing shorter recovery times and favorable outcomes. Among these, the endoscopic transorbital approach (ETOA) has emerged as a versati...
Endoscopic techniques have enabled minimally invasive approaches in neurosurgery, providing shorter recovery times and favorable outcomes. Among these, the endoscopic transorbital approach (ETOA) has emerged as a versatile surgical modality. Despite the growing body of evidence, complication rates associated with ETOA have not yet been systematically evaluated. We systematically searched PubMed, Embase, Scopus, and Web of Science up to March 2026. We included studies enrolling ≥ 5 patients who underwent ETOA as the sole surgical modality to treat both skull base and orbital lesions, providing data on early or long-term complications. A single-group meta-analysis was performed using a random-effects model with 95% confidence intervals. Heterogeneity was assessed with the I² statistic and further explored through Baujat plots and sensitivity analyses. A total of 11 observational studies, comprising 269 patients, were included. Overall, 21 different pathologies were reported. Meningioma represented the most frequent lesion (60.6% of cases), followed by schwannoma (12.0%), cavernous hemangioma (4.6%), and glioma (2.7%). Mean follow-up was 27.6 ± 15.1 months. CSF leak was observed in 1% (95% CI: 0.00 to 0.04, I² = 46.5%), and wound infection was observed in 3% (95% CI: 0.01 to 0.07, I²=0%). Ptosis occurred in 4% (95% CI: 0.00 to 0.14, I²=79.4%) and diplopia occurred in 6% (95% CI: 0.01 to 0.14, I²=68.9%). Medial gaze palsy occurred in 9% (95% CI: 0.04 to 0.18, I²=8.8%). Improvement in visual function was seen in 47% (95% CI: 0.22 to 0.73, I²=88.7%). Visual dysfunction occurred in 1% (95% CI: 0.00 to 0.04, I²=48.6%). Transient facial numbness occurred in 16% (95% CI: 0.09 to 0.25, I²=35.0%). Mortality was 0% (95% CI: 0.00 to 0.02, I²=28.7%). ETOA is a safe and promising technique for managing a wide range of skull base and orbital lesions. Future prospective and comparative studies are needed to refine indications and validate its long-term efficacy.
Multi-center pressure reactivity index temporal trajectories for predicting outcome in comatose subarachnoid hemorrhage patients.
Chang JJ, Foreman B, Kepplinger D … +5 more , Kim Y, Felbaum DR, Mai JC, Armonda RA, Aulisi EF
Neurosurg Rev · 2026 May · PMID 42120701 · Publisher ↗
Pressure reactivity index (PRx) is a surrogate for cerebral autoregulation and has been used for prognostication in aneurysmal subarachnoid hemorrhage (SAH). We examined patient-specific temporal courses of PRx and ident...
Pressure reactivity index (PRx) is a surrogate for cerebral autoregulation and has been used for prognostication in aneurysmal subarachnoid hemorrhage (SAH). We examined patient-specific temporal courses of PRx and identified time thresholds that optimized the accuracy of PRx monitoring. Comatose patients with SAH from two Comprehensive Stroke Centers were identified and received continuous ICP and PRx recordings. Outcomes were dichotomized into "poor" versus "good" based on disposition and modified Rankin score. Smoothed PRx trajectories were created to generate "candidate features", looking at daily average PRx and cumulative first-order and second-order changes in PRx. "Candidate features" were used to perform penalized logistic regression analysis. Penalized logistic regression models that maximized specificity for poor outcome were iteratively generated and evaluated sensitivity changes over time. We evaluated 33 comatose SAH patients in this cohort. Average PRx trajectories for good and poor outcome groups diverged at post-ictus day 6. When targeting specificities ≥ 78.6% for poor outcome, sensitivities for predicting poor outcome maximized to 70% (± 7%) at post-ictus day 8 and remained between 55% and 65% for the remainder of the monitoring period up to day 23. Area under curve-receiver operating characteristic (AUC-ROC) curves consistently demonstrated AUC-ROC > 0.71 after post-ictus day 8 (maximum AUC-ROC 0.78 at day 8). We found that when using PRx time-thresholds for predicting poor outcome in comatose SAH patients, prognostication with PRx was maximized at post-ictus day 8. Longer PRx monitoring did not improve predictive power. Further study is required to validate these findings.
Feasibility of short-course antibiotic therapy for surgically treated brain abscess guided by 4-week MRI.
Seo J, Jeong H, Jeong EO … +4 more , Lee HJ, Kim SH, Yang K, Kim KH
Neurosurg Rev · 2026 May · PMID 42115533 · Publisher ↗
Brain abscess is a life-threatening intracranial infection typically managed with surgery followed by prolonged intravenous antibiotics. This study aimed to evaluate the feasibility of a short-course intravenous antibiot...
Brain abscess is a life-threatening intracranial infection typically managed with surgery followed by prolonged intravenous antibiotics. This study aimed to evaluate the feasibility of a short-course intravenous antibiotics regimen after surgery and to assess the utility of 4-week MRI as a biomarker to guide treatment discontinuation. This retrospective study included 60 patients who underwent surgery for bacterial brain abscess at a tertiary center between 2011 and 2024. A scheduled 4-week MRI including diffusion-weighted imaging was performed to assess radiologic resolution. The clinical outcomes, including recurrence, treatment-related adverse events (AEs), and 6-month functional outcomes, were investigated. Patients were categorized into short-course and conventional groups according to antibiotic duration (< 35 vs. ≥35 days), based on the cut-off value for predicting the development of severe AEs. There was no recurrence in both groups. Severe AEs occurred in 22 patients (36.7%), and the most common severe AE was neutropenia followed by severe drug eruption. Patients in the short-course group had significantly fewer severe AEs (P = 0.007) and better functional outcomes at 6 months (P = 0.032) compared to the conventional group. Prolonged antibiotic use was the only independent risk factor for severe AEs (P = 0.036). 4-week MRI was performed in 42 patients (70.0%), and all 25 patients in the short-course group underwent the 4-week MRI and met the resolution criteria. A short-course intravenous antibiotics therapy following surgical evacuation was effective and safe when guided by MRI at 4 weeks, which served as a reliable indicator to confirm resolution and safe treatment discontinuation.
Determinants of long-term visual outcomes after tumor debulking in children with sporadic optic pathway glioma.
Niu J, Zhou W, Liu Y … +1 more , Tian Y
Neurosurg Rev · 2026 May · PMID 42113409 · Publisher ↗
OBJECTIVE: The surgical management of sporadic optic pathway glioma (OPG) remains controversial due to its unpredictable visual outcomes and uncertain risk-benefit balance. This study aimed to identify key clinical and s...
OBJECTIVE: The surgical management of sporadic optic pathway glioma (OPG) remains controversial due to its unpredictable visual outcomes and uncertain risk-benefit balance. This study aimed to identify key clinical and surgical determinants of long-term visual preservation following tumor debulking in children with sporadic OPG. METHODS: A total of 192 pediatric patients who underwent initial partial resection for sporadic OPG at Beijing Tiantan Hospital between 2011 and 2023 were retrospectively analyzed. Two complementary outcomes were assessed: follow-up visual acuity (VA) of the better-eye defined at baseline and individual visual change. Ordinal and binary logistic regression analyses were performed to identify predictors, supplemented by trend and visualization analyses. RESULTS: Baseline VA was the strongest predictor of follow-up VA of the baseline-defined better-eye (OR = 5.88, P < 0.001). Poorer outcomes were associated with younger age (< 3 years), delayed surgery, extent of resection ≥ 50%, and postoperative radiotherapy. Among patients with moderate baseline VA, a greater resection extent showed a trend toward worse outcomes. The anterior interhemispheric approach was linked to higher risk of visual deterioration, whereas transcallosal and frontotemporal approaches were protective. Early intervention, limited resection, and careful avoidance of high-risk surgical corridors were associated with better long-term visual preservation. CONCLUSIONS: Preoperative baseline VA determines postoperative visual potential, while surgical timing, extent, and approach critically shape long-term outcomes. Patients with moderate baseline VA are the most intervention-sensitive subgroup. These findings support early, conservative, and function-oriented surgical strategies to optimize visual outcomes in pediatric sporadic OPG.
Evaluation of functional, structural, and electrophysiological optic nerve changes following extradural anterior clinoidectomy in patients without preoperative optic canal compression.
Aladdam M, Gürbüz MS, İshakoğlu G … +3 more , Esen F, Tombul T, Çalış F
Neurosurg Rev · 2026 May · PMID 42104188 · Full text
Extradural anterior clinoidectomy is increasingly used to improve exposure and proximal vascular control in aneurysm surgery, but its isolated effect on an otherwise uncompromised optic nerve remains unclear. To evaluate...
Extradural anterior clinoidectomy is increasingly used to improve exposure and proximal vascular control in aneurysm surgery, but its isolated effect on an otherwise uncompromised optic nerve remains unclear. To evaluate the functional, structural, and electrophysiological impact of EAC with optic canal unroofing in patients without preoperative optic nerve compression or optic canal pathology. We conducted this single-center study included 16 adults who underwent no-drill extradural anterior clinoidectomy (EAC) during microsurgical clipping of ruptured aneurysms (January 2023-December 2024). Patients with visual or optic pathway pathology were excluded. Postoperative assessment (6-12 months) included visual acuity, automated perimetry (visual field index, VFI), OCT-derived retinal nerve fiber layer (RNFL) thickness, and visual evoked potentials (P100 latency). Eyes were compared using paired tests, with repeated-measures ANOVA for quadrant-based ΔRNFL. Visual acuity was preserved in all patients. Global RNFL thickness was similar in ipsilateral and contralateral eyes (95.8 ± 12.7 vs. 99.2 ± 18.6 μm; p = 0.230). Quadrant ΔRNFL varied by quadrant, but no pairwise differences remained after correction, with a trend toward greater thinning in the superior quadrant. VFI was similar (p = 0.7); one patient had inferior nasal quadrantanopia and two had mild blind-spot enlargement. P100 latency was comparable (114.8 ± 9.7 ms vs. 113.8 ± 8.9 ms; p = 0.223). No major EAC-related neurovascular complications were observed. Extradural anterior clinoidectomy was not associated with statistically significant optic nerve impairment, although visual field changes occurred in 3/16 patients (18.75%) with a trend toward superior RNFL thinning.
Effectiveness and safety of proton therapy in intracranial meningioma treatment: a systematic review and meta-analysis.
Wijaya JH, Elashry AR, Javaid S … +8 more , Yasser M, Jibu B, Narayanan B, Perez-Chadid DA, Azmi A, Avila-Madrigal JP, Ginalis EE, Nanda A
Neurosurg Rev · 2026 May · PMID 42104122 · Full text
Meningiomas are the most common primary intracranial tumors, often treated surgically. However, complete resection is frequently limited by proximity to critical structures, necessitating adjuvant or definitive radiother...
Meningiomas are the most common primary intracranial tumors, often treated surgically. However, complete resection is frequently limited by proximity to critical structures, necessitating adjuvant or definitive radiotherapy. Proton therapy offers dosimetric advantages over photon-based radiotherapy, particularly in sparing adjacent normal tissues. This study aims to systematically evaluate the effectiveness and safety of proton therapy for intracranial meningiomas across tumor grades and clinical scenarios. A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines using PubMed, EMBASE, Scopus, Web of Science, and Cochrane from inception to November 10, 2025. Studies were eligible if they reported clinical outcomes of proton therapy in ≥ 10 adult meningioma patients. Data extraction and risk-of-bias assessment were performed independently by two reviewers. Pooled complication rates and survival outcomes were calculated using random-effects models. Nineteen studies involving 1,431 patients were included. WHO Grade I tumors comprised 70.6% of cases; Grades II/III made up 25.2% and 4.2%, respectively. The most common proton dose regimens ranged from 13 to 70.2 Gy (RBE). The pooled complication rate was 16% (95% CI 5-27; p < 0.001; I² = 98.5%). Nine studies reported a statistically significant 5-year overall-survival proportion of 91% (95% CI 88-94; p < 0.001; I² = 49.3%). Radiologic local control averaged 71% (95% CI 50-86; I² = 88.2%). Proton therapy provides effective tumor control with acceptable toxicity, especially for low-grade or anatomically complex meningiomas. It is a valuable option for select patients, though further prospective studies are needed to optimize dosing and assess long-term outcomes.
Reinitiating antiplatelet therapy in chronic subdural hematoma: Does adjunctive middle meningeal artery embolization improve outcomes?
Essibayi MA, Kakadiya J, Salim HA … +11 more , Chen H, Azzam AY, Dmytriw AA, Yedavalli VS, Kassar MA, Colasurdo M, Gandhi D, Khatri D, Haranhalli N, Altschul DJ, Lakhani DA
Neurosurg Rev · 2026 May · PMID 42103984 · Full text
The optimal timing for reinitiating antiplatelet therapy after treatment of chronic subdural hematoma (cSDH) remains uncertain, especially when middle meningeal artery embolization (MMAE) is used as an adjunct to surgery...
The optimal timing for reinitiating antiplatelet therapy after treatment of chronic subdural hematoma (cSDH) remains uncertain, especially when middle meningeal artery embolization (MMAE) is used as an adjunct to surgery. This study evaluated the safety and outcomes of early antiplatelet reinitiation in patients undergoing combined surgical evacuation and MMAE, and compared outcomes in antiplatelet-treated patients receiving surgery with versus without MMAE. Adult cSDH patients from the TriNetX database (May 2020-May 2025) were identified using ICD-10 and RXNORM codes. Two propensity score-matched analyses were performed: (1) patients receiving surgery with adjunct MMAE, stratified by antiplatelet initiation within 30 days; and (2) antiplatelet-treated patients undergoing surgery with adjunct MMAE versus surgery alone. Outcomes included rescue surgery and 6-month mortality. After matching, early antiplatelet use in surgery + MMAE patients (n = 163 per group) was not associated with higher rescue surgery rates (OR 0.68, 95% CI 0.32-1.48) or mortality (OR 1.52, 95% CI 0.73-3.20). Among antiplatelet-treated patients, surgery + MMAE (n = 176) had similar rescue surgery rates to surgery alone (n = 176) but significantly lower mortality (10.8% vs. 21.0%; OR 0.46, 95% CI 0.25-0.83, p = 0.009). Early antiplatelet reinitiation appeared safe after cSDH evacuation with adjunct MMAE. The associated lower 6-month mortality with adjunct MMAE in antiplatelet-treated patients is observational and hypothesis-generating, and warrants prospective confirmation.
Deep brain stimulation for freezing of gait in Parkinson's disease: An updated systematic review, meta-analysis, and a single-center clinical experience.
Behboodi M, Abdollahifard S, Assadian K … +7 more , Golabi F, Moshfeghinia R, Dehkordi PK, Rezaei R, Sabet S, Razmkon A, Slavin K
Neurosurg Rev · 2026 May · PMID 42098512 · Publisher ↗
Freezing of gait is a disabling and treatment-resistant manifestation of Parkinson's disease (PD). The effectiveness of deep brain stimulation (DBS) for freezing of gait remains inconsistent across stimulation targets, f...
Freezing of gait is a disabling and treatment-resistant manifestation of Parkinson's disease (PD). The effectiveness of deep brain stimulation (DBS) for freezing of gait remains inconsistent across stimulation targets, frequencies, and medication states. We conducted a systematic review and meta-analysis following PRISMA guidelines to examine how DBS affects freezing of gait in patients with PD. We searched Medline, Scopus, Web of Science, and Cochrane up to September 28, 2025. For synthesis, we combined mean differences and 95% confidence intervals for the Freezing of Gait Questionnaire (FOG-Q) and the Unified Parkinson's Disease Rating Scale (UPDRS) part III across different medication and stimulation settings to calculate the final effect size. Thirty-one studies with 905 patients were included. Of these, 21 provided FOG-Q data, and all reported UPDRS-III results. DBS led to a modest decrease in FOG-Q scores (mean difference [MD] = - 2.99; 95% CI = - 5.69 to - 0.29). The biggest improvement in FOG was seen when stimulation was used while patients were off medication (Med-OFF/Stim-OFF vs. Med-OFF/Stim-ON: MD - 5.88; 95% CI - 9.28 to - 2.47). Stimulation during the medication-ON state had smaller effects (Med-ON/Stim-OFF vs. Med-ON/Stim-ON: MD - 2.65; 95% CI - 4.99 to - 0.32), and there was no significant benefit when comparing Med-ON/Stim-OFF to Med-OFF/Stim-ON (MD - 0.70; 95% CI - 3.88 to 2.48). UPDRS-III scores improved substantially in the medication-OFF state with stimulation (MD - 14.35; 95% CI - 17.39 to - 11.32). High-frequency stimulation targeting the subthalamic nucleus provided more consistent benefits, yet substantial variation persisted across studies. The results of our small cohort showed significant improvement in FOG-Q and UPDRS-III (P values = 0.034, 0.022, respectively). DBS improves freezing of gait primarily in the medication-OFF state, with greater effects observed using high-frequency stimulation and subthalamic nucleus targets. Significant heterogeneity and limited data for alternative targets warrant cautious interpretation and further controlled studies.
Neuroworsening in traumatic brain injury: A consensus of the Latin American Brain Injury Consortium (LABIC) and the Latin American Federation of Neurosurgical Societies (FLANC) expert group.
Godoy DA, de Amorim RLO, Paranhos JL … +18 more , Santiago K, Paiva W, Carrizosa J, Vázquez F, Acurio P, Flecha J, Grille P, Domeniconi G, Patiño CR, Vences MÁ, Rovegno M, Altez DEH, Jibaja M, Faleiro R, Zenteno M, Bottani L, Rabinstein A, Rubiano AM
Neurosurg Rev · 2026 May · PMID 42095959 · Full text
Neuroworsening (NW) after traumatic brain injury (TBI) is a life-threatening complication affecting at least one in five patients. The current definition remains heterogeneous and does not integrate contemporary neuromon...
Neuroworsening (NW) after traumatic brain injury (TBI) is a life-threatening complication affecting at least one in five patients. The current definition remains heterogeneous and does not integrate contemporary neuromonitoring tools that could help reduce this variability. Current diagnostic approaches are predominantly reactive, identifying deterioration only after brain herniation has occurred. To establish an expert consensus to update the definition of NW in TBI by proposing a stratified diagnostic framework aligned with precision and personalized medicine principles, aiming to shift a paradigm that has been in use for the past 50 years. A formal Delphi consensus process was conducted involving 25 experts from the Latin American Brain Injury Consortium (LABIC) and the Latin American Federation of Neurosurgical Societies (FLANC). A pre-consensus systematic literature review was performed, followed by structured electronic surveys with Likert-scale and multiple-choice items. Consensus was predefined as ≥80% agreement for establishing a statement. A 95.2% response rate was achieved in the first Delphi round, with 100% of statements reaching the consensus threshold. The panel agreed on a stratified three phenotype NW framework: Established NW, Subclinical NW and High-Risk Phenotype, including patients with pre-existing anatomical or systemic conditions that affect cerebral compliance or oxygenation reserve. This consensus proposes integrating clinical, imaging, and multimodal neuromonitoring parameters to update the definition of NW, thereby reducing heterogeneity in the current concept. Seven statements were established with >80% agreement. The new definition promotes a preventive approach to this critical condition, in contrast to the traditional reactive model.
Detailed evaluation of the long-term outcomes of repeat stereotactic radiosurgery for brain arteriovenous malformations: A single-center retrospective study.
Hirata T, Umekawa M, Hasegawa H … +4 more , Shinya Y, Katano A, Koizumi S, Saito N
Neurosurg Rev · 2026 May · PMID 42091744 · Publisher ↗
Repeat stereotactic radiosurgery (SRS) is a treatment option for residual brain arteriovenous malformations (AVMs) following incomplete response to an initial SRS, and this study aimed to clarify the long-term outcomes....
Repeat stereotactic radiosurgery (SRS) is a treatment option for residual brain arteriovenous malformations (AVMs) following incomplete response to an initial SRS, and this study aimed to clarify the long-term outcomes. Patients who underwent repeat SRS between 1990 and 2022 were retrospectively analyzed. Primary outcome was a favorable patient outcome, defined as AVM obliteration without post-SRS hemorrhage or symptomatic T2 signal change/late radiation-induced complications (LRICs). Fifty-eight patients with a median follow-up of 97 months were analyzed. Six patients (10.3%) experienced recurrent hemorrhage between the initial and repeat SRS, indicating high risk of hemorrhage in this cohort. Favorable patient outcome was achieved in 41 patients (70.7%), with 3- and 5-year cumulative rates of 68.1% and 79.2%. Maximum dose was associated with a favorable patient outcome (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.01-1.14; p = 0.016). AVM obliteration was achieved in 47 patients (81.0%), with 3- and 5-year rates of 69.2% and 85.0%. Three patients (5.2%) experienced post-repeat SRS hemorrhage, with an annual hemorrhage rate of 1.66%/person-year. Five patients (8.6%) experienced LRICs requiring resection with 5- and 10-year rates of 4.0% and 6.9%. T2 signal change after initial SRS (HR 17.11, 95% CI 1.06-276.55; p = 0.046) and initial maximum diameter > 25 mm (HR 21.12, 95% CI 1.01-442.76; p = 0.049) were associated with LRICs. Repeat SRS demonstrated long-term favorable outcomes in patients at a high risk of hemorrhage. A longer follow-up duration is important, as in the case of LRICs, which could be predicted by T2 signal change and nidus size before repeat SRS.
Stand-alone porous titanium cages for anterior cervical discectomy and fusion: clinical outcomes in a multicenter experience.
Panico F, Colonna S, Bozzaro M … +10 more , Gatto A, Ceroni L, Comite LM, Petrone S, Ajello M, Marengo N, Bavaresco E, Zullo N, Garbossa D, Cofano F
Neurosurg Rev · 2026 May · PMID 42071061 · Full text
BACKGROUND: Porous titanium cages have emerged as a promising alternative to traditional interbody materials in anterior cervical discectomy and fusion (ACDF), potentially enhancing osteointegration while maintaining mec...
BACKGROUND: Porous titanium cages have emerged as a promising alternative to traditional interbody materials in anterior cervical discectomy and fusion (ACDF), potentially enhancing osteointegration while maintaining mechanical stability. This multicenter study evaluates clinical and radiological outcomes following stand-alone ACDF using 3D-printed porous titanium cages. METHODS: This retrospective observational study included 120 patients (mean age 54.8 years) who underwent stand-alone ACDF across three tertiary spine centers. Clinical outcomes were assessed using the Numerical Rating Scale (NRS) and Short Form-12 (SF-12). Radiological outcomes at 12 months included fusion, subsidence, migration, and sagittal alignment parameters. Fusion assessment at 12 months was performed using CT or dynamic flexion/extension radiographs. RESULTS: At 12 months, interbody fusion was achieved in 106 patients (88.3%; 95% CI: 81.4%-92.9%). NRS scores significantly improved (mean reduction 4.2 points; p < 0.001), while SF-12 showed no significant change. Cage subsidence occurred in 7 patients (5.8%), with no cases of migration. Cervical sagittal alignment parameters remained stable over time, with no significant differences after correction for multiple comparisons. No significant associations were identified between preoperative variables and adverse radiological outcomes. CONCLUSIONS: Stand-alone ACDF with porous titanium cages is associated with high fusion rates, significant pain reduction, and low complication rates at 1 year. These findings support the use of porous titanium cages as a viable option in non-plating cervical fusion strategies, although further comparative studies are warranted to better define their relative performance. CLINICAL TRIAL NUMBER: Not applicable.
Correction to: Surgical screening protocol for craniocervical instability secondary to ehlers-danlos syndrome and other connective tissue disorders: analysis of a 347 patient case series.
Bloom AR, Biggins JB, Brodbelt A … +13 more , Nishikawa M, Foroughi M, Ruhoy IS, Dass R, Rohana K, Wood JD, Putrino D, Rohde V, Bettag C, Belverud S, Caton T, Bolognese PA, Choudhri T
Neurosurg Rev · 2026 May · PMID 42071056 · Full text
Abstract loading — click title to view on PubMed.
The research of subdural effusion collection complicating cerebral revascularization following ventriculoperitoneal shunting in adults with hemorrhagic moyamoya disease: A retrospective case series.
Lu W, Chaoran Z, Xinhua C … +12 more , Lingyun W, Yuanyuan S, Yi W, Wei L, Chunhua H, Juan W, Lei Z, Yi L, Rong W, Bo Z, Zhiyong S, Yongbo Y
Neurosurg Rev · 2026 May · PMID 42068407 · Publisher ↗
Ventriculoperitoneal shunting (VPS) helps reduce intracranial pressure and alleviate clinical symptoms caused by hydrocephalus in hemorrhagic Moyamoya disease (MMD). To date, no literature describes the occurrence of sub...
Ventriculoperitoneal shunting (VPS) helps reduce intracranial pressure and alleviate clinical symptoms caused by hydrocephalus in hemorrhagic Moyamoya disease (MMD). To date, no literature describes the occurrence of subdural fluid collection (SDFC) in hemorrhagic MMD patients undergoing VPS prior to cerebral revascularization. This report aims to explore the potential pathological mechanisms underlying SDFC following cerebral revascularization after prior VPS, and to provide effective strategies for future prevention. Clinical data of hemorrhagic MMD patients undergoing VPS prior to bypass admitted to our hospital from 2021 January and 2024 December were selected. Medical records were reviewed to analyze patient characteristics and the entire disease course. Among the 7 patients (9 cases), postoperative SDFC occurred in 7 cases (7/9, 77.8%), located contralateral to the shunt in 6 cases (6/7, 85.7%) and ipsilateral to the surgical side in 1 case (1/7, 14.3%), with onset mostly within 1 day after surgery. Among these 7 patients, 2 underwent subdural drilling and drainage due to significant mass effect caused by the effusion. One of these patients developed herniation with decreased consciousness and notable midline shift, and symptoms gradually improved after subdural drainage. Durin-g short-term clinical follow-up (postoperative period < 12 months), recurrent hemorrhage occurred in 1 out of 9 cases, while no cases of cerebral infarction or seizures were observed. CT angiography (CTA) revealed occlusion of the bypass graft in 2 out of 6 direct bypass cases. Through the findings of this study and literature review, we observe that cerebral revascularization performed during the late phase of VPS may induce SDFC complications through multiple mechanisms. Future implementation of early intervention may effectively reduce the risk of adverse events and improve surgical outcomes.
Deep brain stimulation for clozapine-resistant schizophrenia: a systematic review of target-specific outcomes and stereotactic technical considerations.
Armando AR, Fahmi A, Subianto H … +7 more , Turchan A, Wang W, Peng Y, Kamaruddin MF, Syaharani R, Zamzam RR, Maulina N
Neurosurg Rev · 2026 May · PMID 42067731 · Full text
Treatment-resistant schizophrenia (TRS) affects approximately 20-30% of patients, and a substantial proportion develop clozapine-resistant schizophrenia (CRS). Deep brain stimulation (DBS) has emerged as a potential neur...
Treatment-resistant schizophrenia (TRS) affects approximately 20-30% of patients, and a substantial proportion develop clozapine-resistant schizophrenia (CRS). Deep brain stimulation (DBS) has emerged as a potential neurosurgical intervention targeting dysfunctional cortico-striato-limbic circuitry. However, technical heterogeneity and limited clinical data constrain interpretation of outcomes. This systematic review was conducted in accordance with PRISMA guidelines and prospectively registered in PROSPERO (CRD420251080715). Seven electronic databases were searched from inception through January 31, 2025. Clinical studies investigating DBS in TRS or CRS were included. Methodological quality was assessed using Joanna Briggs Institute (JBI) tools. Data extraction emphasized stereotactic targeting methods, hardware configurations, stimulation parameters, and clinical outcomes. The total number of study is 6. We excluded paper by Manssuer 2023. The total study population comprises 21 patients. Seven studies involving 21 patients met inclusion criteria. Targets included the nucleus accumbens (NAcc; n = 11), substantia nigra (SNr; n = 1), habenula (HB; n = 2), subgenual cingulate (SCG; n = 4), subgenual anterior cingulate cortex (sgACC; n = 3). Reported PANSS total score changes ranged widely (11%-85.7%), reflecting substantial inter-individual variability and methodological limitations. Surgical complications occurred in 3 of 21 patients (14.2%), including infection and hemorrhage. All cases utilized open-loop stimulation and conventional cylindrical leads. Current evidence suggests a preliminary therapeutic signal for DBS in highly selected CRS patients, particularly with NAcc targeting. However, conclusions remain limited by small sample sizes, technical heterogeneity, and absence of controlled trials. Future investigations should prioritize standardized stereotactic reporting, volumetric lead reconstruction, and long-term safety assessment within specialized neurosurgical research settings. PROSPERO CRD420251080715.
Sequesterectomy versus standard micro‑/open discectomy for lumbar disc herniation: a systematic review and meta-analysis.
Apostolakis S, Haliasos N, Stavrinou LC … +1 more , Stavrinou P
Neurosurg Rev · 2026 May · PMID 42067681 · Publisher ↗
Lumbar disk herniation is a common clinical entity affecting about 1% of the entire population every year. The purpose of the present work is to provide a systematic review and meta-analysis comparing the safety and effi...
Lumbar disk herniation is a common clinical entity affecting about 1% of the entire population every year. The purpose of the present work is to provide a systematic review and meta-analysis comparing the safety and efficiency of sequesterectomy and discectomy in the management of lumbar disk herniation. A systematic review and meta-analysis using the random effects method was performed. This search was applied through the 6th of March 2025 to PubMed, Scopus, Cochrane Central Register of Controlled Trials and the Directory of Open Access Journals. The data collected included patient demographics, spinal level at which the operation occurred, duration of operation and hospital stay, outcome, recurrence rate as well as potential immediate and delayed complications. A total of 18 original studies with a cumulative number of 4394 patients were identified. No statistically significant difference was found in the re-herniation and complication rate between the two groups (OR: 1.058, 95% CI: 0.726-1.541, p=.769 and OR: 1.399, 95% CI: 0.964-2.032, p=.077 respectively). The same applied for mean hospital stay (standard difference in means: 0.206, SE = 0.167, p= .219). In contrast, mean operating time was found to be significantly shorter in the sequesterectomy group than in the discectomy group (mean 58.086 min versus 72.885 min respectively). As or the patient reported outcomes, VAS score for back pain two years after the operation was the only index that was significantly higher in patients with discectomy (standard difference in means: 0.348, SE = 0.172, p= .04). Based on the available data, the two approaches do not differ in terms of risk of reherniation, reoperation rate and postoperative complications. Nevertheless, patients that have undergone sequesterectomy could potentially benefit from a more significant reduction in back pain in the long run.
The efficacy of ventriculosubgaleal shunt in managing neonatal hydrocephalus due to intraventricular hemorrhage: a systematic review and meta-analysis.
Gomes Cabral Junior S, Sousa MP, Ribeiro FV … +10 more , Pereira MAOM, Camerotte R, Fukunaga CK, Almeida CVF, Brenner LO, Ferreira MY, Batista S, Ribeiro FFT, Bertani R, Brito HN
Neurosurg Rev · 2026 May · PMID 42067675 · Publisher ↗
Intraventricular hemorrhage (IVH) is a severe complication in premature neonates, occurring in 25%-30% of cases and often leading to posthemorrhagic hydrocephalus (PHH). When blood clots in the cerebrospinal fluid (CSF),...
Intraventricular hemorrhage (IVH) is a severe complication in premature neonates, occurring in 25%-30% of cases and often leading to posthemorrhagic hydrocephalus (PHH). When blood clots in the cerebrospinal fluid (CSF), preventing permanent shunt placement, temporary interventions are considered. Ventriculosubgaleal shunt (VSGS) utilizes the subgaleal space to absorb and drain excess CSF, reducing infection risk and allowing hydrocephalus control until the neonate reaches an appropriate weight and CSF clarity. This systematic review and meta-analysis evaluate the safety and efficacy of VSGS in treating neonatal PHH. A systematic review was conducted using Medline, Embase, and Web of Science following Cochrane and PRISMA guidelines. Eligible studies included those with ≥ 4 neonates. The primary outcomes analyzed were VSGS-related infection, VSGS revision, VSGS catheter migration, catheter obstruction, VSGS-related CSF leakage, permanent ventriculoperitoneal shunt (VPS) placement, overall mortality, and procedure-related mortality. A total of nineteen studies, encompassing 562 neonates, were included in our analysis. The pooled VSGS-related infection rate was 9% (95%CI: 5% to 12%). The need for VSGS revision was observed in 4% of cases (95%CI: 0% to 8%). The catheter obstruction rate was 2% (95% CI: 0% to 5%), while VSGS catheter migration occurred in 1% of cases (95%CI: 0% to 5%). VSGS-related CSF leakage was reported in 6% of neonates (95%CI: 3% to 9%). Permanent VPS placement was required in 75% of patients (95%CI: 67% to 82%). The overall mortality rate was 10% (95%CI: 4% to 16%), and the procedure-related mortality rate was 1% (95%CI: 0% to 2%). This systematic review and meta-analysis identified VSGS as a safe and effective option for treating hydrocephalus caused by IVH in premature neonates.
The fundal cerebrospinal fluid cap in vestibular schwannoma surgery: a predictor of outcome after the retrosigmoid approach.
Dolovac RB, Lai L, Jones J … +4 more , Ovenden C, Kam J, Arena G, Castle-Kirszbaum M
Neurosurg Rev · 2026 May · PMID 42067635 · Full text
The fundal cerebrospinal fluid (CSF) cap is a radiological finding correlating to a pocket of CSF lateral to vestibular schwannomas in the fundus of the internal acoustic meatus. Its presence may increase the likelihood...
The fundal cerebrospinal fluid (CSF) cap is a radiological finding correlating to a pocket of CSF lateral to vestibular schwannomas in the fundus of the internal acoustic meatus. Its presence may increase the likelihood of good facial nerve outcome and hearing preservation after microsurgical resection. A systematic review of the literature was performed. Studies that reported the association of a fundal fluid cap with postoperative outcomes including facial nerve outcome, hearing preservation and extent of resection were included. A total of 17 studies were included, comprising 2370 patients. Studies were generally at high risk of bias. The presence of a fundal cap was associated with significantly higher rate of good (HB I-II) facial nerve outcome after retrosigmoid approaches (OR 6.04; 95%CI 2.79-13.11), but not after translabyrinthine and middle fossa approaches. A fundal cap was associated with an increased rate of gross total resection (OR 2.13; CI: 1.51-3.00) and hearing preservation after retrosigmoid (OR 3.37; 95% CI: 2.32-4.90), but not middle fossa approaches (OR 1.47; 95% CI: 0.89-2.44). A fundal cap was also predictive of hearing preservation after radiosurgery. The fundal CSF cap is an important predictor of facial nerve function and hearing preservation after retrosigmoid craniotomy for vestibular schwannoma. Its importance in middle fossa and translabyrinthine surgery is less clear, which reflects the anatomical considerations of each approach. The presence or absence of a fundal cap should be documented preoperatively and used to guide more nuanced risk assessment for preoperative patient counselling.
MRA-based aneurysm occlusion assessment in the early phase after flow diverter treatment: a multicenter retrospective study focusing on the impact of aneurysm diameter.
Koizumi S, Shojima M, Yanai K … +8 more , Kiyofuji S, Dofuku S, Sato D, Umekawa M, Fujitani S, Ono H, Miyawaki S, Saito N
Neurosurg Rev · 2026 May · PMID 42062610 · Full text
BACKGROUND: Although it is well-known that most aneurysms occlude within 1 year after flow diverter (FD) treatment, the time course to occlusion, especially in the early period, has not been adequately studied. METHODS:...
BACKGROUND: Although it is well-known that most aneurysms occlude within 1 year after flow diverter (FD) treatment, the time course to occlusion, especially in the early period, has not been adequately studied. METHODS: This study included patients treated with FDs between April 2018 and December 2024 and underwent at least 3 months of imaging follow-up with MRA. The primary outcome was aneurysm occlusion without rupture during follow-up. Cumulative aneurysm occlusion rates were assessed using repetitive time-of-flight and ultrashort echo-time MRA. Predictors of aneurysm occlusion were analyzed with special interests to patient backgrounds, anatomical factors including aneurysm diameter, and procedural details. RESULTS: This study included 119 patients (male: female ratio, 15:104; mean age, 58 ± 14 years; average diameter, 10.8 mm). During the median follow-up of 12 months, the cumulative occlusion rates at 3, 6, and 12 months were 15%, 48%, and 79%, respectively. Receiver operating characteristic analysis identified the diameter threshold of 10.9 mm to best predict its occlusion, and aneurysms larger than this cutoff showed lower cumulative occlusion rates (P = 0.002 [log-rank test], hazard ratio 0.49 [P = 0.003]). In the multivariable Cox hazard model, an increase in aneurysm diameter (Hazard ratio 0.92, P = 0.002) was a preventive factor for aneurysm occlusion, whereas adjunctive coiling (Hazard ratio 2.05, P = 0.009) significantly promoted the occlusion rate. CONCLUSIONS: In postoperative follow-up using repetitive MRA, larger aneurysms exhibited the trend to occlude slower after FD treatment, whereas adjunctive coiling promoted the time course to aneurysm occlusion. Future prospective studies are warranted to investigate technical factors to further promote aneurysm occlusion. CLINICAL TRIAL NUMBER: UMIN000057450.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe